Lecture: Medications for Chronic Asthma Treatment

Introduction

• Mnemonic: I Like Lazy Saturdays
  • I: Inhaled Corticosteroids
  • Like: Leukotriene Modifiers
  • Lazy: Long-acting Beta-2 Agonists
  • Saturdays: Short-acting Beta-2 Agonists

Inhaled Corticosteroids (ICS)

• First-line treatment for asthma control.
• Mechanism: Reduces inflammation in the lungs by binding to glucocorticoid receptors, inhibiting inflammatory gene transcription and activation.
  • Inhibits cytokines, eosinophils, and mediators (e.g., leukotrienes, histamine).
• Examples: Budesonide, Beclomethasone, Fluticasone, Mometasone.
• Mnemonic for Side Effects: HOCUS
  • H: Hoarseness
  • O: Oral thrush (candidiasis)
  • C: Cough
  • U: Upper respiratory tract infections (rare)
  • S: Sore throat

Beta-2 Agonists

• Types: Short-acting (SABA) and Long-acting (LABA)
• Mechanism: Bind to beta-2 receptors on airway smooth muscles, increasing cyclic AMP, reducing calcium release, leading to bronchodilation.

Short-acting Beta-2 Agonists (SABA)

• Use: Rapid action within 5 minutes, used as rescue inhalers.
• Examples: Albuterol, Levalbuterol.
• Side Effects: Increased heart rate, palpitations, increased BP, anxiety, tremors, hyperglycemia, hypokalemia.
• Usage: Monitor use frequency, use before exercise.

Long-acting Beta-2 Agonists (LABA)

• Duration: Lasts 12+ hours, used for daily control.
• Examples: Salmeterol, Formoterol.
• Combination: Used with ICS, e.g., Simbacort (Budesonide + Formoterol), Advair (Salmeterol + Fluticasone).
• Side Effects: Similar to SABA.

Metered Dose Inhaler (MDI) Use

• Mnemonic: SPORT
  • S: Shake well
  • P: Prime before first use
  • O: Out (exhale deeply)
  • R: Rest inhaler in mouth
  • T: Take a deep breath, hold for 10 seconds
• Tip: Use spacers for children.

Leukotriene Modifiers

• Function: Block action of leukotrienes, reducing bronchial contraction, inflammation, and nasal congestion.
• Examples: Montelukast, Zafirlukast, Zileuton.
• Side Effects: Headache, dizziness, abdominal pain, mood changes.
• Dosing: Based on age, not weight.

Other Medications

Theophylline

• Use: Declined due to side effects, narrow therapeutic index.
• Mechanism: Believed to block phosphodiesterase.
• Side Effects: Nausea, headache, tachycardia.

Inhaled Anticholinergics

• Short-acting: Ipratropium for acute exacerbations.
• Long-acting: Tiotropium for uncontrolled asthma.
• Side Effects: Dry mouth.

Omalizumab

• Use: Moderate to severe allergic asthma.
• Mechanism: Inhibits IgE binding on mast cells.
• Requirements: Administer in healthcare settings due to anaphylaxis risk.

Management Strategy

• Start with SABA as needed.
• Escalate therapy with increased doses of controllers.
• Consider leukotriene modifiers for patients with allergies.

Conclusion

• Assess symptoms, monitor patients' use of rescue inhalers.
• Adjust treatments based on response and side effects.